| Providence Service Corporation | |
|
2 Davenport Cir Suite 4; Achieve Program Bath ME 04530-2880 | |
| (207) 443-6200 | |
| Not Available |
| Full Name | Providence Service Corporation |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2 Davenport Cir, Bath, Maine |
| Authorized Official Name and Position | Nicole Zenga (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 2073730620 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Service Corporation Po Box 758866 Baltimore MD 21275-8866 Ph: (207) 373-0620 | Providence Service Corporation 2 Davenport Cir Suite 4; Achieve Program Bath ME 04530-2880 Ph: (207) 443-6200 |
| NPI Number | 1710222534 |
|---|---|
| Provider Enumeration Date | 12/05/2012 |
| Last Update Date | 12/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710222534 | NPI | - | NPPES |
| 191700000 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 392123 (Maine) | Primary |
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